Stroke in the elderly is one of the most common causes of mortality or disabilities among elderly, in the whole world. With age, the occurrence of stroke increases up to 50% of all happening in 75 years old and over, and 30% of all strokes happening in elderly over 85 years old. Besides being in greater risk of having a stroke, elderly have poorer chances for good functional outcomes after a stroke.
I’ll try to explain here what stroke actually is, how and why types differentiate depending on the cause, how to recognize one, if you witness someone having a stroke, who can be in greater risk of a stroke, what are the treatment and recovery prognosis and how can it impact your life. And finally, I’ll offer some thoughts on prevention, as well.
What Happens During Stroke
Let’s understand first how and why stroke happens. Our brain needs oxygen to work. Brain cells cannot survive more than a few minutes without it. This is exactly what happens when blood does not deliver nutrients and oxygen to this organ-brain cells start to die. Every minute up to a whopping 1.9 million brain cells.
The treatment is therefore time critical, and can only be successfully provided in the first couple of hours of the stroke. The earlier the patient receives the treatment, the better the chances for a good outcome are.
Depending on which parts of the brain are affected and how severely, this can seriously damage the brain and cause a long term disability, sometimes even death.
We differentiate two main types of the stroke today. The most common one is caused by blocking the arteries that are supposed to deliver oxygen and nutrients to the brain. Plaque, a substance containing primarily fat, calcium and cholesterol builds up in arteries. When these plaques form in the carotid arteries, it is called Carotid Artery Disease. If not broken down by the body, the plaques will narrow these blood vessels, which are the suppliers of blood to the brain.
Thrombocytes, which are meant to repair injuries in the body, can get confused by a plaque, viewed as an injury of the blood vessel. This confusion will trigger the formation of clots in an attempt to heal the supposed injury. The clots may block blood vessels and cut off blood flow to the brain cells. When it happens, it is called Ischemic stroke.
About 80 percent of strokes are ischemic, one of the two kinds: thrombotic, which happens when a blood vessel is narrowed by a plaque, mostly under a condition called atherosclerosis. Not being able to flow freely, blood tends to clot, which will easily block the already narrowed blood vessel.
The other kind is embolic, which is caused purely by a clot, which might be traveling from anywhere in the body and carried by the stream successively arrives into the smaller and smaller vessels, where it will block the one that’s its size in diameter.
These clots are often formed in the heart, due to a condition where heart beats in abnormal, rapid rhythm. Unable to follow this rhythm, two upper chambers quiver instead of beating, holding so the blood long enough to prompt clotting.
The other type is the rupture of a blood vessel which will then leak into the brain, again stopping the normal blood flow. Moreover, it will cause additional pressure on the brain and irreversible damage. This type is called Hemorrhagic stroke. Sometimes a weak part of the artery can blow up like a balloon and burst any time. This balloon-like bulge is called aneurysm.
Also, a mesh of not fully developed arteries and veins can break in the brain. High blood pressure may weaken blood vessels by putting pressure on the inner walls, thus making possible their burst, as well. Both these conditions can cause hemorrhagic stroke.
A milder version of ischemic stroke also exists, and is quite frequent in the elderly over 65. It usually has no longer impact, luckily- the blockage is broken down by the body quickly. Being temporary only, it mostly does not cause lasting brain damage. Still, the negative effects of possibly repeated occurrences can stack up. This stroke is usually referred to as TIA, or transient ischemic attack.
“Having a transient ischemic attack (TIA), or “mini stroke,” can reduce your life expectancy by 20 percent, according to a new study in Stroke” Journal of the American Heart Association, 2011.
National Heart, Lung and Blood Institute posted a two-minute explanatory video about stroke types. You can watch it here
Symptoms of TIA:
-severe sudden headache
-unusual numbness, muscle weakness or temporary paralysis in face, arm or leg, typically on one side of the body. A very mild TIA will still have a sign in form of slightly lowered one corner of mouth.
-sudden confusion, memory loss, dizziness
-significantly newly aggravated walking
-troubled balance and movement coordination
-difficulty speaking and/or understanding others
-difficulty seeing in one or both eyes, blindness or double vision
-change in sense of taste or smell
Symptoms of a major stroke are the same, except they won’t go away quickly, sometimes, unfortunately, even ever.
As a TIA is mostly a warning sign that a major stroke is on its way in the near future, it is essential to seek medical help immediately after one. A timely medical examination and precautions taken might help to minimize the risk and save one’s life.
It can also be a precursor of vascular dementia. In fact, this serious condition may be caused by a single or a series of strokes which reduce blood flow to parts of brain.
This mnemonic is a quick help when you suspect someone is suffering a stroke in your presence.
F stands for face-did one corner of the mouth or the whole face drop?
A stands for arms-can the person raise both arms, or one is drifting downward?
S is for speech-ask a person to say his/her name, or to repeat a simple sentence. Does it sound as a normal speech, or is it slurred or garbled?
T stands for time-which there isn’t any to waste. An urgent help must be called at once – do not drive the victim to the hospital yourself. The ambulance personnel will start helping the person already on the way to the hospital. Every minute is extremely important.
-high blood pressure,
-heart and blood vessel diseases
-high LDL cholesterol levels
-once already experienced stroke or TIA increases the risk of another one
-men are in somewhat greater risk
-stroke is also more likely as we age
-Stroke is a condition that is not exactly considered hereditary, but some inherited factors can increase the risk. Also, families tend to have similar lifestyle choices which can lead to similar risks
Further, these life style habits may increase the risk of having a stroke:
-high salt and high fat intake
-sedentary life style-lack of exercise
Treatment of TIA and major stroke equally, will depend on the severity and type of the stroke. In any case it aims to correct any irregularity that might have caused it and to prevent possible further TIAs or major strokes in the future. It may include medication which will stop or significantly reduce clotting of the blood, like anti-platelet and anticoagulant drugs. If a high blood pressure is present, lowering it will also be included into treatment.
In other, more severe cases a surgery might be the right solution, where either the artery will be opened, cleaned from plaque and closed back, or placing a small tube into the artery where there is a need to support keeping it open. This procedure is better known as stenting. At hemorrhagic stroke it might be necessary to surgically open the scull to remove the leaked blood and repair the blood vessels of the brain.
Recovery-Trying to Get Back to “Normal” Life
Recovery may be a difficult and long journey for a stroke survivor. Sometimes full recovery is not possible at all and sadly can leave you or your loved ones, who suffered a stroke, with lifelong complications or disability.
As different parts of the brain are “assigned” to deal with different tasks, the impact of the stroke will depend on the part of brain affected.
If suffered a stroke, you or your loved ones may need to work on memory, on the ability to think, to speak, to understand others, to read or write. Coordinating movements of your limbs might be difficult, so you might have to learn again how to walk, dress, eat.
A therapist for each of the disabilities needs to be involved, to maximize the chances of returning to normal life.
Any of the muscles may be weakened, or nerves affected, so besides difficulties with everyday tasks, one might also not be able to control bladder or bowels. Constipation can also be one of the issues.
A vision loss may occur when a part in the field of vision has been affected. Double or blurred vision is also common.
Training and additional helping devices, such as walking canes, wheelchairs, dressing aids, special cutlery might make you feel more comfortable while doing your daily activities. You might need some home modifications as well.
Exercising is also a very good tool to regain strength and coordination over your muscles after a stroke. You can download an excellent guide to it here.
Behavioral Changes and Mental Health After a Stroke
Any of the complications individually is frustrating enough, let alone a few of them simultaneously. A stroke survivor is usually quite stressed with suddenly not being able to live a normal life as so far. When on top of it he/she perceives the unforeseen disabilities as embarrassing, or as a personal failure, or a major life injustice, it can seriously affect his/her mental health, as well.
Sometimes, after a stroke, a feeling of anger, an unconscious iresistable need for others to feel bad, sort of “punishing” them for being well and able to live normally (not having had a stroke) can drive a person to behaviors that can’t be appreciated by the caregiver(s) and immediate surrounding. This negative attitude can be very difficult for them to adjust to, while the person might not realize at all behaving differently.
Close after the stroke, the emotional manifestations are often either too strong or too weak, compared to what we would consider normal, or what they would have been prior to the stroke. Uncontrollable laughter or crying might occur and you wouldn’t even know why it started. Changes in your personality also may be present, sometimes for the worse.
It is important for you to know that these behavioral changes can, in time and with a help of a specialist, be channeled back close to normal for you. Your doctor will prescribe medication and/or recommend behavioral therapies, so it is essential that you are open about how exactly you feel.
Professional therapists, specialists can help with each of these issues, but the support of your surroundings, friends and family will play a huge part in the recovery, relieving anxiety and stress you may experience and might be the trigger for your unusual behavior.
If you are the caregiver or family to such a person and you find it hard to cope, you should seek support for yourself, as well. Do not feel as if you were betraying your loved one who had a stroke if you admit she/he has changed to the point where you need help to deal with this new behavior. Maybe join a caregiver support group for the start and go on from there.
Prevention-More Than 80% of Strokes Might Be Preventable,
a 2016 research shows.
As with many other medical conditions, prevention primarily includes a healthy lifestyle:
-Eating a healthy, nutrient packed diet, especially at older age, as needs significantly change with age.
-maintaining a healthy body weight, as this decreases the risk of a stroke
-taking care of being sufficiently hydrated, as dehydration may cause the thinning and therefore slower flow of blood with nutrients and oxygen for the brain.
-keeping physically active, exercising regularly, thus keeping the whole body generally in good shape
-keeping under control existing medical conditions, like high blood pressure or cholesterol, diabetes
-stop smoking, as it damages blood vessels, possibly causing plaque formation
We have seen in this article that a stroke can seriously change lives-of the victim and of the family around the victim. I’ve said it before, but-one ounce of prevention is worth a pound of cure, and nothing could be more true when it comes to strokes, so try to act accordingly.
If your only takeaway from this article will be F.A.S.T.- it was already worth of it. But if you also embrace the recommendations for preventing this possibly deadly condition-I’m already very pleased. You’ve done something good for your or for the health of your loved one.
Hopefully, you did not have any experience with strokes, but, if you did, would you share it with us? I’d really appreciate it and anyone reading it might learn from it.
As always, feel free to reach out should you have any questions and I’ll be happy to give you the answer to the best of my knowledge.
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